Provider Demographics
NPI:1467446104
Name:LITTEL, COREY J
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:J
Last Name:LITTEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43800 SASSAFRAS DR
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619-4113
Mailing Address - Country:US
Mailing Address - Phone:301-342-9226
Mailing Address - Fax:301-342-8491
Practice Address - Street 1:48110 SHAW RD
Practice Address - Street 2:BLDG 2187 SUITE 1240-G3
Practice Address - City:PATUXENT RIVER
Practice Address - State:MD
Practice Address - Zip Code:20670-1906
Practice Address - Country:US
Practice Address - Phone:301-342-9226
Practice Address - Fax:301-342-8491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer